Most therapists have never had a course in nutrition. But what if your clients’ depression or anxiety is more connected to their diet and gut bacteria than to their relationships, or fears, or traumatic childhood?
That’s the question that Joan Borysenko—author of 16 books about biology, psychology, and spirituality, including the bestselling Minding the Body, Mending the Mind—wants you to consider. She used her Harvard doctorate in medical science to become a pioneer in the field of integrative medicine, exploring the role of meaning and spirituality in health and healing. After a perilous experience with a dietary change, she delved into the literature of nutrition and mental health, resulting in her latest book, The PlantPlus Diet Solution: Personalized Nutrition for Life. It turns out you really are what you eat, even on an emotional level. She’ll be a featured speaker at the 2017 Networker Symposium.
RH: What got you interested in studying nutrition?
BORYSENKO: Seven years ago, my husband, at age 65, found that he had some calcifications in his arteries, which isn’t unusual at that age. So we followed the traditional advice and went on an ultra low-fat vegan diet. We decided if that’s what it was going to take to reverse coronary artery disease, we’d do it. We did it religiously for 14 months, and I have to say, we were completely obnoxious about it. We were like holy rollers telling people this is what they should eat, too.
But on this diet—advertised as eat all you want and you’ll lose weight—we both gained 10 pounds, which is a lot, especially for a woman who’s only 5’3”. It was completely counterintuitive. Then my cardiologist had me calling in every day because he was so worried about my blood pressure. Then my husband’s triglycerides, the circulating fat in his blood, went through the roof. His high-density lipoproteins, the good cholesterol, dropped down. It was all very peculiar, and I started to wonder, What’s wrong with this picture? It’s clear that some people—Bill Clinton, apparently—thrive on a diet like this, but for us, not so much. It actually put us in a much more precarious situation, healthwise.
RH: So what went wrong?
BORYSENKO: None of our physicians could make heads or tails of this, because they had zero training in nutrition. So I thought to myself, Okay, I have a doctorate in medical sciences from Harvard Medical School. I’m a cell biologist. I really dig research, and I know how to do it. Why don’t I look at the nutrition literature? It took me three years to go through it all.
RH: What did you find?
BORYSENKO: Among other things, the fact that the government decided to give us a bogus food pyramid. You might’ve seen in the New York Times lately that some Harvard researchers, long since dead, were actually paid off by the sugar industry to change their data and blame fat instead of sugar for obesity. This is bad science—crooked science, actually. The entire view of fat has changed in the past few years. Good fats (organic cold-pressed olive oil, coconut oil, avocado oil, and fats from animals that are pasture raised) are good for most people, and they don’t lead to weight gain. What’s made people fat is carbohydrates—and we all have different carb tolerances. Generally, it breaks down to insulin sensitivity. People with great insulin sensitivity can live on French bread morning, noon, and night, and wash it down with Coke, and their weight and blood sugars will stay stable.
RH: And what did you find about cholesterol?
BORYSENKO: Well, here’s a food–mood link for you. For years, the literature has indicated that for men, the lower their cholesterol, the more prone they were to depression, because you need cholesterol for your brain and your nervous system to function. There’s an excellent correlation between low blood cholesterol and depression.
RH: Both the good and the bad types of cholesterol?
BORYSENKO: I’m talking about the so-called bad cholesterol. Incidentally, only half of people who have heart attacks have high cholesterol. Also, studies show that older women need to have higher cholesterol than they did when they were younger. As for my own health, I could fall into a tub of lard, and my LDL cholesterol wouldn’t go much above 70. I have congenitally low cholesterol. This actually worries me.
RH: There’s so much conflicting information out there about these kinds of things—which makes it really difficult to know what to eat.
BORYSENKO: Yes. That’s why it took me three years to make any sense of it. And things get even more muddled when Big Pharma gets in the way. You have to realize that the statins are the best-selling drug of all time, an amazing cash cow. So we’re putting people on drugs that lower their cholesterol beyond what may be physiologically appropriate for their body. And, of course, what’s appropriate is going to differ from person to person. Fortunately, there’s a burgeoning field of personalized nutrition out there. Just as therapists wouldn’t use the same interventions with all their clients, nutrition should be individualized as well.
RH: Do genetics make a difference here?
BORYSENKO: Yes, and there are three genomes. The one you get from mom and dad, the DNA from your gut bacteria—called the microbiome (a whopping 99 percent of your DNA)—and the epigenome. Epigenetics is a relatively new field within the last decade that’s really taken off. Epi means above the gene. While the genome changes slowly over many years, the epigenome can create immediate change by turning genes on or off. Food is a common epigenetic modulator. I had my genetic profile done, which also gave me some information about an important epigenetic modular called folate. The profile specifies what kind of diet you should eat and what studies that’s based on. It also tells you about eating behavior, believe it or not, which should be interesting for psychologists. For example, I have a gene—I couldn’t believe there were genes for these things—that essentially predicts that if there’s some tasty food around that I really like, I’ll have trouble controlling myself. Even though I’ve never had any trouble with my weight, no pack of potato chips is safe around me. I’m not an emotional eater. It’s just that I have trouble controlling myself around food I find tasty. Fortunately, knowing this, it’s easy to control by not having that food in the house. But also just knowing about the gene made me feel better about myself. I’m not a weak-willed slob after all.
RH: Understanding that reduced shame about your willpower?
BORYSENKO: That’s exactly right. There’s so much psychological baggage around weight and eating, so it’s a very interesting thing to understand. But that’s just the genetics part. There’s another important thing to consider: our gut bacteria. Many more of our neurotransmitters are made by our gut bacteria than by our brain. So there’s an enormous correlation between food and mood here, because when you eat, you’re not just feeding yourself: you’re feeding your gut bacteria, the underpinnings of both your immune system and your nervous system. It turns out that the gut–immune and the gut–brain interactions are where the real action is, and gut bacteria vary tremendously from person to person. There’s major interest in transplanting bacteria for conditions as diverse as immune disorders and weight control. Right now, the only bacterial transplant that’s FDA approved is for people who have Clostridium difficile (or C diff), a bacterium that kills 14,000 people a year.
RH: This is the fecal transplant procedure?
BORYSENKO: Yeah. But I predict that within the next five years, we’re going to be doing fecal transplants to treat obesity. It’s already happening in Europe. Think about it: there are people who’ve got gut bacteria that are terrific if you live in a famine, because these bacteria can extract every last calorie from fiber, but not so good in a time of plenty, when we’ve got too much stuff to eat.
RH: So this transplant would help people lose weight?
BORYSENKO: Yep. And fecal transplants from healthy people can also help many chronic illnesses. We’re actually a composite ecosystem that’s more bacterial than human. One of the ecosystemic functions of these 100 trillion bacteria is to make small fatty acids that keep the gut lining intact, and if you don’t have the right gut bacteria, or if you haven’t been feeding them the right things, then your gut epithelium begins to leak. That’s a prime cause of autoimmune disease. Then you can end up with colitis. You can end up with connective tissue disease. I ran a mind/body clinic for years, and some of the people who had what we thought were stress-related illnesses were probably actually suffering from a food-related illness.
I’m sure these clients got much better from learning mindfulness techniques and doing cognitive behavioral therapy, but we were missing the elephant in the living room: nutrition. A major problem comes down to the fact that most people don’t feed their innate probiotics, or good bacteria. These gut bacteria eat fiber, different kinds of fiber. The American diet is very low in fiber, and the government fiber regulations are way below what people need to eat.
RH: So what can we do?
BORYSENKO: Pretty simple. Eat whole, organic foods with plenty of veggies and fiber. While the diet needs to be personalized for our metabolism, the basis of a good diet for almost everyone is a pound of vegetables a day. Some of that can be fruit, but how much depends on your ability to deal with carbohydrates. A pound of veggies really isn’t that much: only about three and a half cups of something like carrots, celery, broccoli, cauliflower. You should also eat plenty of leafy greens. Starting your day with a green smoothie and having a big salad for lunch is an easy way to go. For most people, this in itself will do a tremendous amount for both physical health and mood. You also need to eat healthy fats, and if you eat meat, it should come from happy, healthy animals that have been fed diets that are organic and appropriate for them. Overall, I think if somebody tells you, “Oh, I’m anxious,” and you realize that even though this person is thin, he exists on junk food, that’s the place where therapy needs to start.
RH: What message do you have for psychotherapists?
BORYSENKO: As always, knowledge is power. If you don’t understand the crucial connection between food and mood, you can’t explain it to clients, nor can you ask the right questions about their diets. I’m on a crusade for nutritional literacy. The bottom line is that for most people, a whole foods, organic diet based largely on vegetables and fruit and good fats (let’s remember that omega-6 fatty acids are one of the best treatments for depression) optimizes health. Discovering whether you need animal protein, can metabolize dairy, deal with gluten, or have specific issues with micronutrients is at the heart of personalization. And it’s not hard to figure out.